| NPI | 1821384843 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: KY 05404) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: KY TP240) |
| 208100000X Physical Medicine & Rehabilitation (Licence: KY 05404) | |
| 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: OH 34.011803) | |
| 207Q00000X Family Medicine (Licence: OH 34.011803) | |
| Enumeration Date | 2011-06-28 |
| Last Update Date | 2023-10-05 |